Comparison of bougie-guided cricothyrotomy and traditional cricothyrotomy techniques in an obese 3D-printed surgical airway manikin: a randomized controlled study.

Background: Obesity is one of the conditions that may require invasive airway management. The effectiveness of invasive airway techniques in obesity is not fully understood, and there is no routinely recommended technique. This study aimed to compare the first attempt success rate, procedure time, and difficulty of traditional surgical cricothyrotomy and bougie-guided cricothyrotomy on a 3D-printed surgical airway manikin made obese using simple techniques.

Methods: The study was designed as a prospective randomized controlled study. The obese simulation was created with a 3D-printed surgical airway manikin and sponge layers. Bougie-guided cricothyrotomy and traditional cricothyrotomy techniques were taught to emergency residents, and they were asked to practice the technique on the designed manikin. The duration of the procedure for both techniques, the number of attempts, the success rate, and the difficulty scores of the techniques were recorded.

Results: A total of 24 residents were included in the study. As the first technique, 13 residents used bougie-guided cricothyrotomy. A total of 23 (95.8%) were successful with both techniques. In the traditional surgical cricothyrotomy, 7 (31.8%) residents were successful on the first attempt, while in the bougie-guided cricothyrotomy, 15 (68.2%) residents were successful on the first attempt (p = 0.020). In residents with less than 2 years of seniority, the mean difficulty score of the bougie-guided cricothyrotomy was lower (p = 0.024).

Conclusions: The success rate of the bougie-guided cricothyrotomy in the first attempt was higher than that of the traditional surgical technique. There was no statistically significant difference between the overall success rates and procedure times of both methods. The level of difficulty of the bougie-guided cricothyrotomy was found to be easier, especially for residents with less than two years of seniority.

Presentations: The manuscript has been presented 9th EurAsian Congress on Emergency Medicine (oral presentation) at the 9-12 November, 2023, Antalya, Turkey, and won the best oral abstract award at this congress.